Medium-to-Long-Term Outcomes of Tricuspid Regurgitation After Transcatheter Closure of Ventricular Septal Defect in Children

Abstract

Background and Objectives

Transcatheter closure of ventricular septal defect (VSD) is an effective treatment for children. However, the changes in tricuspid regurgitation (TR) after the closure remain unclear. This study aimed to assess the fate of TR after transcatheter VSD closure.

Methods

The patients were categorized into a none/mild preoperative TR group and a moderate/severe preoperative TR group. Changes in TR severity postprocedure were evaluated, and risk factors for persistent TR were identified.

Results

A total of 942 children were enrolled, comprising 892 with none/mild TR and 50 with moderate/severe TR. The median follow-up time was 22.4 months (range 6–109 months). Among the 50 children with preoperative moderate/severe TR, 36 cases (72%) demonstrated significant improvement in TR, whereas 14 cases (28%) maintained persistent TR after closure. Of the 892 children with preoperative none/mild TR, 28 cases (2.9%) developed postoperative persistent TR (24 moderate and 4 severe). Among these 28 cases, 6 were new onset, and the remainder all resulted from progression. 73% of postoperative severe TR cases occurred within the first 24 hours after closure. A VSD located behind the tricuspid septal leaflet and occluder size/VSD right ventricular size ≥ 2.5 were identified as risk factors for postoperative persistent TR.

Conclusions

TR in children with VSD is common and typically mild, both before and after closure. A larger ratio of occluder size to VSD right ventricular size, along with a defect located behind the tricuspid septal leaflet, increases the risk of persistent TR. Long-term follow-up is crucial for detecting potential TR progression.